Provider Demographics
NPI:1417428285
Name:EWA, NATASHA (LCSW)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:EWA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 RAVINE GAP DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-3050
Mailing Address - Country:US
Mailing Address - Phone:757-942-2412
Mailing Address - Fax:
Practice Address - Street 1:820 GREENBRIER CIR STE 32
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2646
Practice Address - Country:US
Practice Address - Phone:401-359-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040106611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical